Medway Maritime Hospital

Updated 13 February 2025

Medway Maritime Hospital provides a range of NHS Hospital Services. This assessment looked at urgent and emergency services, which we rated requires improvement. The rating from urgent and emergency services has been combined with ratings of other services from the last inspections. See our previous reports to get a full picture of all other services at Medway Maritime Hospital. The overall rating of Medway Maritime Hospital remains requires improvement. In our assessment of urgent and emergency services we found breaches of Regulation 10, 12, 15, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. As a result of these findings, we served a Warning Notice requiring the trust to make significant improvements to the quality of healthcare in the emergency department. We conducted an evidenced based off-site and on-site assessment of the hospital due to receiving information of concern. We assessed all 8 quality statements for the safe key question. We assessed 2 quality statements for effective and well-led and 1 quality statement for responsive and caring. Across effective, responsive, caring and well-led key questions we have combined the scores for these areas with scores from the last inspection.

Updated 14 November 2024

The Trust provides urgent and emergency services at Medway Maritime Hospital. The emergency department (ED) has a resuscitation area, a majors areas, a rapid assessment unit, urgent treatment centre and clinical decision unit. There is a separate waiting area for children attending ED. Due to concerns received about safe care and treatment of patients, we commenced an off-site assessment of the service on 7 February 2024 together with an on-site assessment on 21 February 2024. We used our focused assessment methodology for this assessment. We did not look at all quality statements for all key questions. We found breaches of Regulation 10, 12, 15, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service did not protect the privacy and dignity of patients. Patients experienced long waits in the department before admission to an inpatient bed. The environment within the emergency department was not suitable for the number of people being accommodated and staff did not have clear policies to support them to provide safe care to patients in non-designated care areas. The service did not ensure there were enough suitably qualified nursing staff to provide safe care and treatment to the number of patients in the department. The service did not manage medicines well and patients did not always receive their medicines on time. The service did not ensure all incidents were reported and acted on. Some staff described a poor culture, with staff fearing reprisal for raising concerns and senior leaders not focused on patient care. As a result of these findings, we served a Warning Notice requiring the trust to make significant improvements to the quality of healthcare in the emergency department. However, the environment was visibly clean. Local leaders provided support, and staff were committed to providing care in challenging circumstances. Staff and leaders were proud that partnership working had reduced ambulance off-load times.

Updated 30 July 2021

Updated 30 July 2021

Updated 30 April 2020

Our rating of this service improved. We rated it as outstanding because:

• The service had made significant improvements to the findings from the last inspection in areas such as nursing and medical staffing, pharmacy support and nursing patients in recovery area. Nursing staff cover now met national guidance, there was no agency nursing staff use and minimal nursing of patients in recovery beds. The service had also taken steps to address the medical cover shortage gaps.
• There was now an embedded positive culture to making sure leaders and staff provided high-quality care. Staff understood the senior leadership structure and said the team were always accessible and visible. They felt there was now stability at middle management level. This had improved from what we found in the last inspection.
• Medical and nursing staff compliance to mandatory training had improved and showed better compliance than the trust target and was better than at the last inspection.
• The service leadership was compassionate, inclusive and effective. Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. Leaders had the skills, knowledge and experience to perform their roles.
• Leaders and staff had a clear understanding of issues, challenges, priorities and vision for their service. The service places patients’ safety and individual needs at the core of its strategy.
• There was strong and collective collaboration, team work and support across all functions and a shared focus on improving the quality, safety and sustainability of care.
• Staff were proud of the service as a place to work and spoke highly of the culture. Staff at all levels were actively encouraged to speak up and raise concerns.
• There was a strong visible person-centred culture to providing care across the service. Staff always treated patients with dignity and respect. Staff were highly motivated, passionate and dedicated to make sure patients received the best individualised patient-centred care.
• Staff understood the impact that a person’s care, treatment or condition had on their wellbeing and on those close to them, both emotionally and socially. Staff saw people's emotional and social needs were equally important as their physical needs.
• Staff involved patients and those close to them in making decisions about their care and treatment.
• All staff actively engaged in activities to monitor and improve quality of care. Leaders and staff proactively pursued opportunities to participate in benchmarking and peer review are proactively pursued, including participation in approved accreditation schemes and research.
• The continual development of staff skills, competence and knowledge was recognised as integral to providing high-quality care. Managers proactively supported and encouraged staff to acquire new skills, use their transferable skills and share best practice. Managers made sure staff received specialist training for their role.
• Staff worked collaboratively and found innovative and efficient ways to deliver more joined-up care to people who use services.
• The service was inclusive and took account of patients’ individual needs and preferences. There was a proactive approach to understand the needs and preferences of different groups of people and to deliver care in a way that meets these needs, which was accessible and promoted equality. This included people with protected characteristics under the Equality Act, people who may be approaching the end of their life, and people who were in vulnerable circumstances or who have complex needs.
• Governance arrangements were proactively reviewed and reflected best practice. The service took a systematic approach to work with other organisations to improve quality of care.
• The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• Openness, honesty and transparency were the norm.
• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix.
• Staff understood their responsibilities and knew the steps to take to protect patients from abuse. They had training to recognise and report abuse and knew how to apply it.

However:

• The high dependency unit did not meet the minimum bed space dimensions as recommended in national guidance.
• Staff did not always keep control of substances hazardous to health (COSHH) secure.
• Patient flow throughout the hospital resulted in delayed discharges and very high occupancy rates. This continued to have a significant impact on discharges from the medical and surgical high dependency units. This delay in discharge also contributed to the majority of mixed sex accommodation breaches the trust reported.
• Out of hours critical care discharges to ward between 10pm and 7am remained a challenge and were worse than the national average. The service relied on the availability of ward beds throughout the hospital and its performance was similar to the last inspection.

Updated 26 July 2018

We previously inspected diagnostic imaging jointly with outpatients so we cannot compare our new ratings directly with previous ratings. We rated it as requires improvement because:

• Systems, processes and practices did not always keep people safe and safeguarded from abuse because;

Cleaning of ultrasound probes did not meet guidance presenting an infection risk.

Resuscitation equipment was not adequately monitored.

Turnover, vacancy and sickness rates were higher than the trust target.

Safety huddles were not sufficiently recorded.

• The provider had not ensured the proper and safe use of medicines because;

Fridge temperatures were not monitored in line with trust policy.

Contrast injections used within CT were not checked by a second registered person as required by local policy and national guidance.

However,

Following inspection, the trust provided us with assurance these issues had been dealt with and would continue to be monitored.

• Waiting times for scans were worse than the national averages in some areas including MRI, CT, ultrasound and dexa scanning.
• Report turnaround times for general imaging was longer than the trust target of five days. The average time from imaging to report taking seven days.
• Changes to the process for obtaining porters to transport inpatients had resulted in delays and waits for patients.
• There was limited space in some areas of the department for patients in wheelchairs.
• There was no formal strategy for diagnostic imaging at the time of inspection. Although the management team had developed a draft strategy it had not been agreed or implemented.
• There were four vacant leadership posts within diagnostic imaging. There good local leadership within the imaging department with staff consistently telling us that imaging department managers were approachable. However, staff said senior trust and directorate leaders were not visible in the department. They felt that changes were implemented without their involvement, consultation or their concerns being listened to.
• IT systems did not support the monitoring of demand, activity and capacity across the modalities within the department.

However;

• The completion of mandatory training was better than the trust target overall.
• There were quality assurance systems to monitor the safety of equipment within the department.
• There was appropriate safety signage within the department.
• Environmental cleaning audit results were consistently good.
• Patient safety incidents were investigated and action was taken to monitor and improve safety. Radiation incidents were reported and monitored in line with legislation.
• A radiation protection advisor, radiation protection supervisors and local rules were present in each modality in diagnostic imaging.
• Chaperones were available patients were receiving care and support from a member of the opposite sex.
• Staff demonstrated understanding of the needs of patients who were vulnerable and those who might be frightened, confused or phobic. Where patients were anxious about the process of the scan, staff made arrangements for them to visit the department prior to their appointment so they were familiar with the process and the equipment in use.
• Staff provided patients with information leaflets and allowed time for discussion prior to procedures.
• Volunteers were available to support patients and we observed them doing so with kindness and respect.
• The diagnostic imaging department conducted their own patient satisfaction survey every six months. Results from the most recent survey showed that 99% of patients felt that their privacy and dignity was respected.
• There were governance procedures in place with sufficient contact and advice for the provision of radiation protection supervisor services. There were regular radiation protection committee meetings and governance meetings and in place.

Updated 30 April 2020

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well.
• The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines in line with best practice. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients enough to eat and drink. Managers monitored the effectiveness of the service and made sure staff were competent.
• Staff consistently monitored and managed patient’s pain to ensure they remained as comfortable as possible
• Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Patients and relatives said staff go above and beyond and the care received exceeded their expectations. Staff truly respected and valued patients as individuals. They treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were clear about their roles and accountabilities.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not have a specialist palliative care consultant.
• The service did not consistently have capacity to deliver end of life care training to staff across the trust.
• The trust did not ensure staff had time to attend end of life care training.
• The service did not keep their risk register fully up to date when they reviewed risks.

Updated 28 April 2023

Updated 26 July 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

• There was no way of monitoring how many medical staff in outpatients were compliant with mandatory training.
• Referral to treatment targets remained consistently worse than the national average on most pathways.
• The response time for outpatient complaints was worse than the hospital’s target.
• The outpatient pharmacy department could not provide assurance that turnaround times were being accurately monitored following issues with the electronic system used to track outpatient prescriptions.
• Signage for the outpatient pharmacy was non-existent.
• The outpatient department did not have oversight of how many medical staff had completed their mandatory training as these staff were managed by their individual speciality.

However:

• The service managed patient safety incidents well.
• The trust monitored patients who could be at risk of harm from a long wait to see a clinician.
• Staff were competent to perform their roles and received regular appraisals.
• Staff cared for patients with compassion and feedback from patients regarding their care was continually positive.
• Risks for the service had been identified at a service level, but wider risks such as the referral to treatment targets were not identified.
• Staff knew and understood the hospital vision and values and told us the culture of the department was positive.
• Staff told us their line managers and senior managers were visible and supportive.

Updated 30 April 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

• While the service improved in some areas since the last inspection, it stayed the same or became worse in others.
• While staff had training in key skills, the service did not always ensure everyone completed them.
• The service did not control infection risk well and staff did not consistently follow infection prevention and control policies. The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Records were not always stored securely.
• While the service had improved staff recruitment, there remained significant challenges within theatres. This caused high reliance on bank and agency staff. This issue was identified at the last inspection and continued to require improvement.
• Staff collected safety information but did not display it for patients and visitors to see.
• Not all staff felt respected, supported and valued and staff morale was low in theatres.
• The service did not ensure patients must ensure that all reasonable steps were being taken to improve the quality of service, specifically in relation to access to treatment and waiting times.
• The service did not ensure products deemed as hazardous to health were stored securely.
• The trust was not meeting the Department of Health and Social Care’s standard on eliminating mixed sex accommodation in the recovery area of theatres.
• Patients were still spending longer than they needed to in recovery awaiting placement in the hospital. Patients staying in recovery for an extended time or overnight had their privacy and dignity compromised.
• The leadership, governance and culture did not always support the delivery of high-quality person-centred care.
• In main theatres staff had not been engaged and morale in the department was low and there was frustrations around leadership, low staffing and capacity and flow issues.
• There was a lack of clarity from managers in theatres on whether staffing was maintained in line with national guidelines.
• There was not an effective, structured review and judgement process for mortality and morbidity meetings.
• The trust was still challenged with getting patients who had a fractured neck of femur to theatre within 36 hours of admission. Performance against this was poor.

However:

• Staff understood how to protect patients from abuse, staff assessed risks to patients, acted on these and kept good care records. They managed medicines well.
• Staff gave patients enough to eat and drink and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent.
• Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff delivered compassionate care and treated patients and their loved ones with respect and dignity. They provided emotional support to patients, families and carers.
• The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
• Staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.